Three Affordable Care Act initiatives often touted as coordinating care and improving outcomes for elderly adults could actually make their circumstances worse, a new study suggests.

The three programs at the center of the study, including the hospital readmission reduction program; the national pilot program on payment bundling; and the community-based care transitions program are inadequate for frail seniors receiving long-term services and supports, claim researchers led by George Washington University's Ellen Kurtzman, MPH, RN.

For example, penalties for hospitals with high rates of readmissions target specific illnesses, such as chronic heart failure. This fails to take into account seniors who are hospitalized frequently for other co-existing conditions. Efforts to reduce readmissions should focus on alignment between acute- and long-term care providers, the paper asserts. Similarly, under bundled payment initiatives, providers are only paid a set amount for an entire episode of care. This model does little to improve care for conditions that are chronic in nature and are excluded from the “bundle.” Finally, the community-based care transition programs, which pair hospitals with high readmission rates to community-based organizations, are unhelpful for individuals living outside the geographic regions where the hospital “hubs” are located, the authors wrote.

To minimize risks associated with these initiatives, Kurtzman urges policymakers to “carefully monitor the law's implementation, advance payment policies that integrate care more fully and support providers in delivery system changes.”

The study will be published in the July print issue of Health Affairs.

A Supreme Court ruling on the constitutionality of the Affordable Care Act is expected this week. The court will decide which — if any — of these and other initiatives pass constitutional muster. In advance of the ruling, Speaker of the House Rep. John Boehner (R-OH) warned fellow House Republicans members that “There will be no spiking of the ball,” should the court rule against the ACA.

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